Allowing Nurses to Practice Independently Does Not Decrease Physician Earnings

March 23, 2012

Advanced practice registered nurses (APRNs) in 16 states and the District of Columbia can diagnose patients and prescribe medications. Those states have granted these highly-educated nurses autonomy or have significantly reduced their barriers to practicing independently, allowing patients greater access to quality care.

A new study from researchers at George Washington University’s School of Public Health and Health Services, supported by the Robert Wood Johnson Foundation (RWJF), finds that physician earnings are largely unchanged in states with fewer barriers for APRNs to practice. The study, by Patricia Pittman, PhD, and Benjamin Williams, MPH, was published in the journal Nursing Research and Practice.

Using data from the Bureau of Labor Statistics, the researchers compared the earnings of family physicians, general physicians and pediatricians in states with barriers to APRN practice to the earnings of physicians in states with fewer restrictions for APRNs. They also compared the earnings of surgeons—who are unlikely to be impacted by nurse practice laws—as a control group.

The researchers found no statistically significant variation in average per-hour earnings for any of the physician groups among the states with differing APRN autonomy laws. “In fact, wages for all three practitioner groups rose at a slightly faster rate between 1999 and 2009 in states with more liberal [scope of practice] laws [than] in states with restrictive laws,” the study says.

“As we plan for the expansion of health care coverage to over 30 million people in 2014, the shortage of primary care providers will be one of the major challenges,” said Pittman, an associate professor in the Department of Health Policy and the School of Nursing, said in a university news release. “As a result, it is important to systematically assess whether there are negative consequences for primary care doctors associated with an expanded role for nurse practitioners. Our study is a first step in that assessment. We found no evidence of negative economic impact on family physicians and internists in states that have already implemented reforms.”

The study results help move the debate about these laws to a different level, Mark V. Pauly, PhD, co-director of the RWJF Interdisciplinary Nursing Quality Research Initiative (INQRI), said in a post on the RWJF Human Capital Blog. “I am pleased that, for once, we may be able to keep money out of what should be an important debate about productivity, quality, and consumer satisfaction.”